Three experts comment on priorities for 2014

There’s a nice little video just posted on the MedPage Today web site in which three well-respected experts give their answers on the question, “What do you anticipate will be the most important clinical development in prostate cancer in 2014?”

Click here to see the video. The commentators are Peter Scardino, MD, of Memorial Sloan-Kettering Cancer Center in New York City, NY; E. David Crawford, MD, of the University of Colorado at Denver, CO; and Derek Raghavan, MD, of Carolinas HealthCare’s Levine Cancer Institute in Charlotte, NC.

What do you think?

5 Responses

  1. So it sounds like they feel rather confident that they have found the right combination of clinical testing to determine if a particular prostate cancers are aggressive and need treatment or do not. How will they be doing this in 2O14?

    If this is true, there should be no further controversy about screening. …

    And the term, “chronic disease” … I’d like to refer to my disease as that. … If you would have asked me when I was in my 20s if I’d want a chronic disease, I would have thought you were crazy … but today … I’m good with that. …

  2. Jerry:

    I think it would probably be wiser to say that “they feel confident that we have much better combinations of clinical tests to determine whether a particular prostate cancer is aggressive and needs treatment or not.” Whether that confidence is fully justified is harder to know. We need more data.

    I do not think that this resolves the screening controversy, because (today) we are still in a situation when most people respond emotionally and irrationally to the word “cancer.” However indolent that “cancer” may be, there are a lot of men who, of their own volition, or because of pressure from family members, will simply decide (inappropriately) that they “want it outta there”. Screening fosters that risk.

  3. Given that at least some of those cancers that men want “outta there” will not be indolent, then at least those men will have avoided developing advanced prostate cancer and/or dying from it. If the true goal is the saving of lives, then screening does accomplish that for some men. Until we have better methods of identifying which cancers are indolent and which are not, the saving of these lives comes at the cost of some men living with side effects from treatments they might not have needed. But, at least, they and the men who have the treatments, are living. As a prostate cancer survivor (mine was not indolent), I just wish the “experts” would acknowledge and explain that they really are talking about a matter of semantics. Saying that “screening” — the testing of all men in a population — is not necessary is interpreted by many men as saying that “testing” — getting checked for prostate cancer –is not nececessary, even for those men at increased risk. As a result, many men who should be getting tested do not, until they wind up with advanced prostate cancer. Is that what the “experts” really want?

  4. Dear Ken:

    This distinction between “screening” and “testing” — as you point out (and as we have been pointing out on the InfoLink for years) — is at the heart of this entire debate — and the mass media have failed to understand this entirely.

    It is worth noting that, in the most recent guidance from the American Urological Association, the guideline’s authors were very careful to talk about “testing”. I think we are making progress, but getting the mass media to appreciate that distinction would be helpful.

  5. I hope they can better define who needs to be treated in 2014 and beyond. Hopefully then help, resources, and advocacy can be directed to the patients who really need it and free the others to live more normal lives.

    I completely agree with the comments regarding the word “cancer” and hope they can come up with a “renaming” convention for indolent disease.

    I have heard this chronic disease concept thrown around a lot and it confuses me quite a bit.

    I do not believe all advanced prostate cancers types can be lumped together, and while some forms may be able to be converted to a chronic state (good news), I think it could be bit misleading. (Maybe this is just too close to home for me.)

    From what I understand, a third of patients receiving either of the new second-line hormone therapies do not respond, and 80 to 95% of those who do respond eventually acquire resistance. It is also quite unclear how those who do go on to progress will respond to sequential therapies. Of course on the other side of the curve there are many who respond well and may take a very long time to progress so I can understand the enthusiasm of those patients. I guess like most things for cancer patients and hope for the best.

    All in all a pretty good outlook 2014 and beyond.


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